Abdominal migraine

Abdominal migraine is a variant type of migraine. It primarily affects children, and is rare in adults. It mainly causes episodes of abdominal pain without an accompanying headache. It is poorly understood. It is difficult to confirm the diagnosis, as periumbilical abdominal pain has an extensive differential diagnosis. It may be treated with analgesia in some patients, and other medications. Avoiding triggers can prevent an episode of abdominal migraine.

Abdominal migraine
SpecialtyNeurology
Symptomsepisodes of abdominal pain
Usual onsetvariable
Causesmigraine triggers
Risk factorscyclic vomiting syndrome, PTSD, functional gastrointestinal disorder
Diagnostic methodsymptoms
Differential diagnosisirritable bowel syndrome, peptic ulcer disease, gastroesophageal reflux disease, mast cell activation syndrome, celiac artery compression syndrome
Preventionavoiding triggers (different for each patient)
Treatmenta range of experimental medications, including TCAs and anticonvulsants
Prognosisgood in pediatrics, variable in adults
Frequencybetween 1% and 9% of children
Deathspoorly studied

Signs and Symptoms

Symptoms of abdominal migraine may include:

These occur in distinct episodes.[5] This can have a significant effect on day-to-day life.[5] It usually does not occur with a headache.[6][7] Body mass index is usually unaffected, and physical development is normal.[5][6]

Causes

Common migraine triggers may trigger abdominal migraines.[1] Psychological stress (such as from school), a change in location (such as travel), changes to sleep, and exercise when this is not wanted, may all cause abdominal migraine.[1]

Pathophysiology

Abdominal migraine is poorly understood.

Diagnosis

As with other types of migraines, there is no diagnostic test to identify abdominal migraines.[3] Diagnosis is based on symptoms, a family history of migraines, and eliminations of other possible causes.[4] It can take time before a diagnosis is made, as symptoms are not specific to abdominal migraine.[6]

Diagnostic criteria from the International Classification of Headache Disorders are:[8]

A. At least 5 attacks fulfilling criteria B-D.
B. Attacks of abdominal pain lasting 1–72 hours (untreated or unsuccessfully treated)
C. Abdominal pain has all of the following characteristics:
1. midline location, periumbilical or poorly localized
2. dull or "just sore" quality
3. moderate or severe intensity
D. During abdominal pain at least 2 of the following:
1. loss of appetite
2. nausea
3. vomiting
4. pallor
E. Not attributed to another disorder

Differential diagnosis

Abdominal migraine must be distinguished from other causes of chronic or recurrent abdominal pain. These include irritable bowel syndrome,[1] peptic ulcer disease,[1] gastroesophageal reflux disease,[1] mast cell activation syndrome, and celiac artery compression syndrome. It must also be distinguished from causes of acute abdominal pain, such as appendicitis, as wrong diagnosis may lead to unnecessary appendectomy.[5]

Treatment

Short term

Analgesia may be effective against abdominal migraine in some patients.[5] Avoidance of intense light tends to have a short-term beneficial effect.[5]

Long term

Avoidance of triggers can be very helpful.[5][6] Medications such as pizotifen, propanolol, and cyproheptadine may be used in rare circumstances.[1][5]

Prognosis

Abdominal migraine can have a significant impact on day-to-day life.[6] Children may miss school or other activities.[6] It resolves in many patients.[5][9] Prognosis is generally good in children, but variable in adults.

Epidemiology

Abdominal migraine primarily affects children, for whom it is a common cause of chronic abdominal pain. It may be as high as 9% or as low as 1% among children.[5] It is rare in adults.[1] However, children diagnosed with abdominal migraines may have migraine headaches as adults.[10] The mean age of diagnosis is 7 years.[7][11] It appears to be slightly more common in women.[5]

History

This condition was first described in 1921 by Buchanan.[12] It was once considered a controversial diagnosis.[13] However, it is now accepted as a common cause of chronic abdominal pain in children.[14]

References
  1. Russell, G; Abu-Arafeh, I; Symon, DN (2002). "Abdominal migraine: evidence for existence and treatment options". Paediatric Drugs. 4 (1): 1–8. doi:10.2165/00128072-200204010-00001. PMID 11817981. S2CID 12289726.
  2. Cuvellier, JC; Lépine, A (Jan 2010). "Childhood periodic syndromes". Pediatric Neurology. 42 (1): 1–11. doi:10.1016/j.pediatrneurol.2009.07.001. PMID 20004856.
  3. "Abdominal Migraine". American Migraine Foundation. Retrieved 2020-08-19.
  4. "Abdominal Migraine: Symptoms, Diagnosis & Treatment > Condition at Yale Medicine". Yale Medicine. Retrieved 2020-08-19.
  5. Angus-Leppan, Heather; Saatci, Defne; Sutcliffe, Alastair; Guiloff, Roberto J. (19 February 2018). "Abdominal migraine". British Medical Journal. 360: k179. doi:10.1136/bmj.k179. ISSN 0959-8138. PMID 29459383.
  6. Catto-Smith, AG; Ranuh, R (Nov 2003). "Abdominal migraine and cyclical vomiting". Seminars in Pediatric Surgery. 12 (4): 254–8. doi:10.1053/j.sempedsurg.2003.08.006. PMID 14655164.
  7. Evans RW, Whyte C. Cyclic vomiting syndrome and abdominal migraine in adults and children. Headache. 2013;53:984–993
  8. Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders, 2nd Edition" (PDF). Cephalalgia. Oxford, England: Blackwell Publishing. 24 (Supplement 1). ISSN 0333-1024. Archived from the original (PDF) on October 30, 2007. Retrieved 4 September 2009.
  9. Napthali, Kate; Koloski, Natasha; Talley, Nicholas J (2016-07-19). "Abdominal migraine". Cephalalgia. 36 (10): 980–986. doi:10.1177/0333102415617748. ISSN 0333-1024.
  10. "Headache: Hope through research". NINDS. April 2016.
  11. Monteferrante, Nikolas, Ho, Jacquelyn, Wilhelmi, Brian, MD, JD, Uribe, Juan. Prevention of Perioperative Abdominal Migraine in a Patient Undergoing Spinal Fusion: A Case Report. A A Pract. 2021;15(6):e01484. doi:10.1213/XAA.0000000000001484.
  12. Tepper, Stewart J.; Tepper, Deborah E., eds. (2011-08-22). The Cleveland Clinic manual of headache therapy. New York: Springer. p. 96. ISBN 9781461401780.
  13. Davidoff, Robert A. (2002). Migraine : manifestations, pathogenesis, and management (2nd ed.). Oxford [u.a.]: Oxford Univ. Press. p. 81. ISBN 9780195137057.
  14. Mani, Jyoti; Madani, Shailender (2018-04-24). "Pediatric abdominal migraine: current perspectives on a lesser known entity". Pediatric Health, Medicine and Therapeutics. 9: 47–58. doi:10.2147/PHMT.S127210. ISSN 1179-9927. PMC 5923275. PMID 29733088.
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